Childbirth in a country practice: a sometimes risky business

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Leongatha Hospital is served by a small number of GP Obstetricians (Photo: David McAlpine)

Expectant mothers in many small rural communities lack much-needed access to specialist doctors in the field of pregnancy and childbirth, experts say.

While pregnancy is an exciting time for mothers, it can be terrifying for those experiencing complications, particularly in rural areas distanced from large metropolitan or regional hospitals with specialist expertise and facilities.

In Leongatha, a town of  5000 people 135 kilometres south-east of Melbourne, a small team of five General Practitioners are qualified to provide obstetric care for low to medium risk patients.

High-risk patients must travel to the nearest regional centre to visit specialist obstetricians because Leongatha does not offer regular visiting consultations.

Leongatha mother Helen Pickering is expecting her second child and is concerned with the lack of specialist obstetricians, particularly the perils of travelling to a larger regional hospital if complications arise.

“It’s obviously becoming an issue because there’s no specialist there in the last week of my pregnancy, when things could go wrong,” she said.

The birth of her first child 10 years ago involved a last-minute complication requiring the local doctors to reposition the baby and deliver using “cups”, to avoid a posterior birth.

The alternative, a Caesarean birth, would have required a specialist anaesthetist to travel almost an hour from the Latrobe Valley to assist.

Ms Pickering said the risk of stillbirth and other complications with her second child is heightened because of her age, however the absence of other risk factors means specialist involvement throughout the pregnancy had not been necessary.

Instead, the GP team has recommended more regular appointments and ultrasounds for Ms Pickering, with the option of inducing the birth a week earlier to reduce potential risks.

Leongatha Healthcare GP Obstetrician Dr Elise Ly said a specialist obstetrician would only travel from another area in extreme circumstances.

“The reality of Australia is you can’t have everyone living close to a tertiary centre,” Dr Ly said.

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Local doctors with training in obstetrics care say they provide a valuable service to their rural community (Photo: David McAlpine)

The Leongatha Hospital delivers about 200 babies a year and provides an operating theatre for the one in five births that by Caesarean section.

GP Obstetrician Dr Sewellyn Gale said pathology and radiology services are available but the hospital lacks a special care nursery for critically ill babies and access to extra blood products.

Dr Ly said the GP obstetrician qualification, which trains general practitioners in primary obstetrics care, ensures they are prepared not only for regular births but also for managing complications and emergencies.

“That’s sort of the expected standard, that if you’re going to provide an obstetrics service and if you’re going to provide theatre services, the people that are providing the services need to be trained in some sort of ‘first aid’ for obstetrics emergencies, before being transferred,” Dr Ly said.

Dr Gale said the service could only provide short-term urgent care for more complex obstetrics emergencies, such as pre-term babies, requiring a specialist obstetrician and more advanced facilities.

“It depends on the level of complexity. So the next step after us would be the regional centres at Traralgon and Warragul,” Dr Gale said.

If it is beyond the capabilities of the nearest regional hospitals, patients are transferred to Melbourne, often to Monash Medical Centre.

GP Obstetrician Dr Joel Fanning said they have to take extra precaution when transferring women in emergency care to a regional hospital because of the potential for complications while being relocated, as well as possible delays if an ambulance is not immediately available.

“You have to take into account the potential for her to progress on the road, so it might be safer to deliver the baby here than to have her delivering in the ambulance on the way over to one of those services,” he said.

Dr Fanning said patient satisfaction remains high because the local service provides individualised care, unlike hospitals in metropolitan areas in which patients may become “lost in the system”.

“The personalised element is wonderful. As health professionals, we enjoy that and I think that the patients enjoy it as well because they have continuity of care,” Dr Fanning said.

“Without bagging the tertiary centres, I think that from my point of view and I think from my patients’ point of view, they have a high level of satisfaction because of the personalised care,” he said.

Dr Ly said there is not a one-size-fits-all solution to obstetrics care.

“I don’t think we’re bagging anyone out, I just think there’s pros and cons of big hospital systems and smaller hospital systems, and being aware of them both means that you can address them,” Dr Ly said.

In order to improve rural maternity services, Dr Fanning said more funding should be directed towards GP obstetricians, particularly to cover after hours work.

“It should be highly valued by the people deciding how much medical staff are remunerated,” Dr Fanning said.

 

David McAlpine is studying a Science and Arts double degree at Monash University and is a freelance science and health journalist. He tweets as @dreamingscience

This article was first published by Mojo News, Monash Journalism’s online magazine www.mojonews.com.au

Monash PhD student designing ‘smart’ drugs using nanoparticles

Written by David McAlpine for Monash University’s Faculty of Engineering.

Imagine a tablet that could reduce the side effects of cancer treatment by releasing a dose of medication at a particular organ or tissue.

Shahrouz Taranejoo, a PhD student in chemical engineering at Monash University, is making this a reality by designing systems that help to target drugs or genes to specific areas and control their release.

His ‘smart polymeric system’ uses several layers of nanoparticles to coat a drug particle, with the sacrificial coatings degrading at different locations as they pass through the digestive system.

Read more on monash.edu

Pottering Around

The tranquility of my garden

There has been much hype in recent years regarding Horticultural Therapy, that pottering around in the garden improves one’s mental wellbeing.

Last year, mental health awareness organisation Beyond Blue shone the spotlight on this humble public health strategy, partnering with nurseries nationwide to promote pottering around in the garden as a way of fostering healthier minds and bodies.

This is not a new concept. It was believed over a century ago that garden and farm surroundings assisted with the health of patients suffering from mental illness in the often oppressive and traumatising asylums.

Scientific studies have demonstrated that horticultural therapy in healthcare settings improves mood state, thus reducing stress and aiding both physical and mental health. One study, for instance, cites subsequent benefits to cardiac health. Other research suggests that ‘wander gardens’, typically designed to assist in the care of sufferers of dementia, also provide the essential first steps in gaining independence when recovering from stroke, improving attention and reducing stress. Furthermore, it has shown to contribute to patients feeling less self-conscious of their post-stroke neurological deficits and thus assisting with their normal rehabilitation program.

This type of environment has the potential to both escape the reality of their illness and exist in peace, at least for a short while, away from the odour of disinfectant, noisy corridors and exhausting physiotherapy sessions. Place definitely has the potential to alter the perception of our reality.

My elderly Great Uncle has been very ill of late but when he is well enough to walk, his first mission is to stand on his back step and check on his backyard full of vegetables. Part of his ‘unofficial’ physical and mental recovery has been tending and nurturing the dutifully sown fruits and vegetables which have not only provided him with great pride but also supplied most of the grateful neighbourhood! It has certainly been a relief from and tastier than hospital food or Meals on Wheels!

On the other side of the world, horticultural therapy has been utilised for many years in the context of the estimated 20% of British military veterans facing invisible wounds of conflict. Before closing in late 2015 due to financial difficulties, the ‘Gardening Leave’ program tended to troubled veterans in their journey with mental wounds and their transition to civilian life, with sessions individually designed to maximise physical, psychological and social strength. The gardens reconnected them back to the reality of civilian life, home and nature and away from the horrors of war.

Further to horticultural therapy being utilised in the hospital setting and for those with physical and mental disabilities, pottering around in one’s backyard garden or simply being at peace on a park bench in the spectacular Royal Melbourne Botanical Gardens is also beneficial for all of us.

During a trip to Sydney this time last year, I disappeared from the city noises by stepping through the gates of my accommodation and into a peaceful and serene garden, bustling with bird life and the evening breeze. Little would one know from the inside that behind the walls and sheltering trees was one of city’s corporate hubs; it felt as though I was at home amongst my own garden.

I am a keen green thumb myself and enjoy escaping from computer screens to immerse myself in the outdoors, whether planting tens of trees or simply pottering around raking and pruning. It is also a family affair; Nanna (my great-grandmother) loved her cottage garden, my Nan planted three acres of bush forty years ago and my Mum has created a two acre oasis from a bare block apart from a few established Eucalypts.

My woodworking is a similar pastime in its objective and application. The wholesome material of timber, the uniqueness of each section of grain, the cleansing nature of its aroma and the sawdust on one’s hands is akin to gardening; one nurturing the plants when alive and the other crafting its products into practical and beautiful forms. The creativity that can be expressed is as beneficial for the mind as it is for the physical activity, just as in gardening. If one is physically able to even perform the simplest of tasks, it allows the mind relief from ‘everyday’ life to connect with nature and its materials, whether in coping with disability or illness or recovering from a tiring week of work.

The place of a tranquil garden connects us back to nature and to what is truly ‘real’. It allows us to escape our busy, stressful, appointment-orientated lives and focus the beauty of natural surroundings and of what we can create with soil and plants.

As musician Joe Cocker sung, the best things in life are the simple things.

Back to the garden for me, then.